Poor sleep can have an impact on MS
Many people with multiple sclerosis complain of sleep problems, such as difficulty falling asleep, being able to get enough sleep or waking up feeling unrefreshed. Poor-quality sleep can be due to physical or mental symptoms of MS, such as muscle stiffness, restless legs, needing a bathroom break in the middle of the night, sleep apnea or anxiety. Less-well appreciated is that poor sleep can also have an impact on MS.
A recent Canadian survey of 743 older people living with MS found that 43% reported difficulties sleeping in the preceding two-week period (Garland and colleagues. Int J Behav Med 2017;24:937-945). Poor sleep was most often associated with other medical conditions. Anxiety was the most important factor – people who were anxious were twice as likely to have sleep problems compared to people without anxiety.
However, the root cause of sleep problems may differ in women and men. A study of 153 people with MS found that pain syndromes were more likely to keep men up at night (Vitkova and colleagues. Brain Behav 2016;6:e00553). In contrast, women were more likely to be suffering from depression or anxiety. This suggests that in some cases, the problem isn’t an inability to fall asleep. The underlying problem may be depression since sleep difficulties are a well-known symptom of mood disorders. Anxious thoughts can make it difficult to fall asleep, while depression can be associated with early-morning wakening. Treating the cause – pain, other physical symptoms or psychological symptoms – can ease mind and body and improve the quality of sleep.
One triple-threat factor that can improve sleep quality, mood and MS fatigue is exercise. A recent study looked at the benefits of starting a regular exercise program (Sadeghi Bahmani and colleagues. Front Psychiatry 2019;10:265). A group of older women and men with MS (average age 51 years) was asked to exercise for about 60 minutes per day during weekdays. At the end of the three-week period, people were spending less time lying awake at night, and had fewer episodes of waking up in the middle of the night. The improvements were shown both subjectively (according to what people said) and objectively (according to EEGs that were recording while they slept). People said that improving their sleep improved their MS and related symptoms, such as depression, fatigue, brain fog and nerve tingling.
The restorative powers of sleep appear to go further than that. A recent study looked at how sleep quality can have a physical impact on MS – something people may have suspected but which science hadn’t yet shown. The study compared people who were “good sleepers” and “bad sleepers” (Buratti and colleagues. Sleep Med 2019;58:56-60). Over the next three years, bad sleepers experienced more MS relapses, and their relapse episodes lasted longer, compared to the good sleepers.
Treating MS is also important since the disease can have a more direct impact on sleep quality. If MS lesions occur in specific parts of the brain, they can cause conditions that interrupt sleep, such as pain syndromes, restless legs syndrome, narcolepsy and other disorders (Foschi and colleagues. Sleep Med 2019;56:90-97). So difficulty sleeping isn’t a trivial matter – it may indicate a medical or psychological problem that needs to be treated. Or it may be your brain’s way of telling you that your MS is flaring up and needs a medication to cool down the inflammation and shrink the lesions more effectively.
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